The role of community pharmacy in diabetes prevention

Background Diabetes Prevention Programmes (DPPs), comprising intensive lifestyle interventions, may delay or even prevent the onset of type 2 diabetes in Non-diabetic hyperglycaemia (NDH). Unfortunately, engagement with DPPs is variable with accessibility being a reported barrier; this may be addressed by community pharmacy involvement given its accessibility. The aim of this thesis was to explore the potential role of community pharmacy in diabetes prevention in England. Methods This thesis includes four studies; the first, a mixed methods study exploring engagement with the national DPP and eliciting views from people with NDH on the role of community pharmacy in diabetes prevention. The second, a qualitative study exploring views of healthcare providers and commissioners on the potential role of community pharmacy in diabetes prevention. The third, a questionnaire-based validation study. The fourth, a nominal group technique study designed to identify interventions most likely to facilitate successful implementation of community pharmacy-based diabetes prevention services (DPS). The studies were underpinned by the Behaviour Change Wheel framework which framed data collection, analysis and intervention development. Results The mixed methods study highlighted barriers to engagement in the national DPP including inconvenient location and session times and identified community pharmacy as a potential setting for delivering alternative DPS. The qualitative study and the subsequent validation questionnaire identified facilitators for the provision of community pharmacy-based DPS including the provision of integrated services in primary care. The final study identified key interventions for ensuring engagement with (e.g. service promotion) and delivery of (e.g. training) community pharmacy-based DPS. Conclusions The thesis provides an overview of evidence underpinning the role of community pharmacy in the provision of accessible DPS and presents a model for implementation. The proposed model, which advocates integration of primary care services, aligns with the community pharmacy contractual framework and the National Health Service Long Term Plan